Necrotizing fasciitis: a cumulative review and new techniques in emergency room diagnosis

Necrotizing fasciitis (NF) is a rare and life threating soft-tissue infection specific to the skin’s fascia layer. It is most often encountered in the peripheries, abdominal wall, and perineum and has numerous etiologies and associated pathogens. Early diagnosis and rapid surgical debridement are essential in treating NF as the infection progresses rapidly and mortality rate increases significantly with time. The current difficulty in initial diagnosis is due to the lack of obvious skin findings early on in the infection. Laboratory tests, including the laboratory risk indicator for necrotizing fasciitis (LRINEC) score, gas on imaging tests, and physical exam findings are the current clues to an early diagnosis but official diagnosis can only be confirmed by surgical exploration and discovery of a lack of resistance to dissection in the fascia layer. The LRINEC score analyzes one variable, specifically C-reactive protein (CRP), which is often not included in routine laboratory tests skin infections at the emergency department (ED). Furthermore, no specific set of physical exam findings has been distinctly associated with diagnosis of NF over other soft-tissue infections and the most specific imaging tests are too expensive for routine use. A new and modified LRINEC score based only on routine ED laboratory tests as well as an additional objective scoring system for physical exam findings are the next steps toward rapid diagnosis. This approach requires large-scale retrospective statistical analyses of NF cases across the country for identification of the most prevalent physical exam findings and abnormal laboratory values